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Making Modern Migraine Medieval: Men of Science, Hildegard of Bingen and the Life of a Retrospective Diagnosis

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Making Modern Migraine Medieval: Men of Science, Hildegard of Bingen and the Life of a Retrospective Diagnosis Med. Hist. (2014), vol. 58(3), pp. 354–374. c The Author 2014. Published by Cambridge University Press 2014 The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence <http://creativecommons.org/licenses/by/3.0/>. doi:10.1017/mdh.2014.28 Making Modern Migraine Medieval: Men of Science, Hildegard of Bingen and the Life of a Retrospective Diagnosis KATHERINE FOXHALL* University of Leicester, School of History, University of Leicester, University Road, Leicester LE1 7RH, UK Abstract: Charles Singer’s retrospective diagnosis of Hildegard of Bingen as a migraine sufferer, first made in 1913, has become commonly accepted. This article uses Hildegard as a case study to shift our focus from a polarised debate about the merits or otherwise of retrospective diagnosis, to examine instead what happens when diagnoses take on lives of their own. It argues that simply championing or rejecting retrospective diagnosis is not enough; that we need instead to appreciate how, at the moment of creation, a diagnosis reflects the significance of particular medical signs and theories in historical context and how, when and why such diagnoses can come to do meaningful work when subsequently mobilised as scientific ‘fact’. This article first traces the emergence of a new formulation of migraine in the nineteenth century, then shows how this context enabled Singer to retrospectively diagnose Hildegard’s migraine and finally examines some of the ways in which this idea has gained popular and academic currency in the second half of the twentieth century. The case of Hildegard’s migraine reminds us of the need to historicise scientific evidence just as rigorously as we historicise our other material and it exposes the cumulative methodological problems that can occur when historians use science, and scientists use history on a casual basis. Keywords: Charles Singer, Migraine, Hildegard of Bingen, Retrospective diagnosis, Medical imagery Introduction In 1913, a young scientist and historian named Charles Singer was in Germany researching precursors to modern theories of contagion. In Wiesbaden, he consulted the twelfth- century illuminated Scivias manuscript (c.1165) which described 26 religious visions * Email address for correspondence: [email protected] I thank the Wellcome Trust, whose generous postdoctoral fellowship (grant no. WT091650MA) has funded the research project of which this article is a part. I am extremely grateful to the anonymous reviewer for Medical History whose thoughtful and critical engagement with this article greatly assisted in its revision, and to Ludmilla Jordanova, Keren Hammerschlag and participants in the CHSTM research seminar at the University of Manchester who commented on earlier versions. Downloaded from https://www.cambridge.org/core. IP address: 170.106.33.19, on 03 Oct 2021 at 08:03:46, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/mdh.2014.28 Making Modern Migraine Medieval 355 experienced by the celebrated St Rupertsberg abbess, Hildegard of Bingen (1098–1179). In the stars, shimmering points of light and crenellated figures of some of the 35 illuminations in Scivias, Singer thought that he recognised depictions of ‘scintillating scotoma’. Noting that Hildegard had admitted to long periods of illness, Singer diagnosed a functional nervous disorder, specifically migraine.1 Nearly a century later, medical ideas about migraine have changed a great deal. Nevertheless, Singer’s retrospective diagnosis of Hildegard’s migraine has persisted, gaining popularity in the late twentieth century as the abbess’ reputation has grown. Hildegard’s migraine has appeared in some significant places, including Oliver Sacks’ Migraine (1970), scholarly publications in medieval history and a pharmaceutical marketing campaign. More recently, on the internet, contributors to blogs and websites have freely proposed Hildegard as a ‘patron saint’ of migraine and migraineurs. There is a large scholarly output in English, German and French by historians specialising in Hildegardian studies. This grapples (among other themes) with whether Hildegard suffered from migraine, whether she was the designer of the Scivias illuminations, and whether she was the author of the medical text Causae et Curae.I should make it clear from the outset that while I am not attempting to make new claims about Hildegard’s own experiences of illness or the authenticity of the works that have been attributed to her oeuvre, this literature has played an important part in informing this piece; each of these three questions has their own independent scholarly history, but they converged in Singer’s argument.2 Instead, I am interested here in tracing a twentieth-century story about how the creation of new medical understandings of migraine provided Charles Singer with evidence to diagnose Hildegard’s migraine and how, subsequently, this diagnosis has been used in different ways to help authenticate particular arguments about illness in the past and present. In doing so, I do not aim to reject retrospective diagnosis tout court. Much of the extant debate on retrospective diagnosis has revolved around the motives of those making the diagnosis, or has traced how historical figures have attracted competing diagnoses as medical knowledge has changed. Here, I wish to use Hildegard as a case study that shifts our focus from a polarised debate about the merits or otherwise of retrospective diagnosis as an act, and to examine instead what happens when diagnoses take on lives of their own. Simply championing or rejecting retrospective diagnosis is not enough. I argue that we need instead to appreciate not only how, at the moment of creation, a diagnosis reflects the significance of particular medical signs and theories in any given historical context but also how, when and why such diagnoses can come to do subsequent meaningful work when mobilised as scientific ‘fact’. The first section of this article charts a pre-history to Singer’s diagnosis, in the emergence of a new dominant medical formulation of migraine in the nineteenth century, which emphasised migraine as a disorder associated with aura, vision and science. The second section examines how Singer used this formulation to identify Hildegard’s 1 Charles Singer, ‘The scientific views and visions of Saint Hildegard (1098–1180)’ in C. Singer (ed.), Studies in the History and Method of Science (Oxford: Clarendon Press, 1917), 1–55: 51–5. Note that Singer was mistaken in his dates; Hildegard actually died in 1179. 2 For general works in English on Hildegard, see eg. Barbara Newman (ed.), Voice of the Living Light: Hildegard of Bingen and Her World (Berkeley, CA: University of California Press, 1998), 3–29; Sabina Flanagan, Hildegard of Bingen: A Visionary Life, 2nd edn (London and NY: Routledge, 1998); Charles Burnett and Peter Dronke (eds), Hildegard of Bingen: The Context of Her Thought and Art (Warburg Institute Colloquia, 4) (London: Warburg Institute, 1988). Downloaded from https://www.cambridge.org/core. IP address: 170.106.33.19, on 03 Oct 2021 at 08:03:46, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/mdh.2014.28 356 K. Foxhall migraine, and how in turn this advanced his own arguments about the medieval development of science. Third, I look at how Hildegard’s migraine took on new life in the second half of the twentieth century in Oliver Sacks’ incorporation of Singer’s ideas and Hildegard’s imagery in his famous study Migraine, and the endeavours of historians to assert the authenticity of Hildegard’s manuscripts, using the migraine diagnosis as evidence. In each case, I show how Hildegard’s migraine has proved attractive not because of its ‘truth’, but because it served to advance a particular argument or position. In the final section, I demonstrate the methodological problems that can result from the decontextualisation and accumulation over time of what Felicity Callard has termed ‘interdisciplinary borrowings’. The case of Hildegard’s migraine reminds us of the need to historicise scientific evidence just as rigorously as we historicise our images and texts.3 Retrospective Diagnosis The issue of retrospective diagnosis has long exercised historians of medicine. Do histories that mine the past for symptoms or traces corresponding to current medical knowledge tell us anything about medical history? Or should we write histories that respect and contextualise historical knowledge on its own terms? This approach accepts, in Andrew Cunningham’s words, that ‘you die of what your doctor says you die of’, however outdated these contemporary pronouncements might now seem to our modern gaze.4 While practitioners of retrospective diagnosis consider the employment of modern biomedical categories as a perfectly valid way to talk about disease in the past, others have criticised the practice’s tendency to reduce the lives of individuals to ‘the mere expression of disease’. Roger Cooter, for example, has dismissed retrospective diagnosis as ‘inherently condescending’.5 The discussion about how to approach histories of disease and illness has re-emerged with renewed vigour in recent years with the publication of a slew of disease ‘biographies’.6 We might usefully think of retrospective diagnosis practice as a broad spectrum, whose ends bear little similarity to each other. At one end of the scale well-funded paleopathology research groups utilise expensive scientific technology to identify pathogens in archaeological remains.7 High-profile examples of this include the 1976 examination of the mummy of Ramses II by French scientists who wished to prove that the Egyptian pharaoh died from tuberculosis.8 The question of whether or not the 3 For an excellent critique of interdisciplinary ‘borrowing’ see Constantina Papoulias and Felicity Callard, ‘Biology’s Gift: Interrogating the Turn to Affect’, Body and Society, 16, 1 (2010), 29–56. 4 Andrew Cunningham, ‘Identifying Disease in the Past: Cutting the Gordian Knot’, Asclepio, 54, 1 (2002), 13–34: 17.
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